Disciplina de Diabetes/Serviço de Diabetes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
Disciplina de Diabetes/Serviço de Diabetes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil,
Arch Endocrinol Metab. 2022;66(4):452-458. doi: 10.20945/2359-3997000000492. Epub 2022 Jun 2.
There is controversy about the indication for nonalcoholic fatty liver disease (NAFLD) screening in patients with type 2 diabetes mellitus (T2D). The present study aims to contribute to NAFLD surveillance in patients with T2D, assessing the association of clinical and biological variables with hepatic stiffness and steatosis.
A cross-sectional design was used, with data collection from electronic medical records, including adults with T2D who underwent transient elastography (TE) between June 2018 and December 2019. Liver stiffness and steatosis were evaluated using TE and controlled attenuation parameter (CAP), respectively, with cutoff points > 8 kpa for increased stiffness and > 275 dBm for steatosis. The relationship between clinical variables and elastography results were evaluated by bivariate correlation and multivariate analysis, using SPSS 27. Seventy-nine patients (n = 79) met the inclusion and exclusion criteria.
Advanced fibrosis and hepatic steatosis were detected in 17,7% and in 21,5% of the patients, respectively. There was a direct and significant correlation between CAP and BMI, waist circumference, HbA1c, triglycerides levels, and insulin doses and an inverse correlation with HDL. The waist circumference, low levels of HDL cholesterol and the insulin dose maintained a significant association with CAP values in multivariate analysis. Elastography values showed an inverse correlation with HDL and a direct correlation with BMI and insulin dose. The association was only maintained for the insulin dose in multivariate analysis.
Our results suggest that clinical factors such as insulin dose, waist circumference, and HDL cholesterol levels could identify T2D patients more likely to present NAFLD.
对于 2 型糖尿病（T2D）患者是否需要进行非酒精性脂肪性肝病（NAFLD）筛查，目前仍存在争议。本研究旨在评估临床和生物学变量与肝硬度和脂肪变性的相关性，为 T2D 患者的 NAFLD 监测提供依据。
采用横断面设计，收集 2018 年 6 月至 2019 年 12 月期间接受瞬时弹性成像（TE）检查的 T2D 成年患者的电子病历数据。使用 TE 和受控衰减参数（CAP）分别评估肝硬度和脂肪变性，肝硬度的截断值＞8 kpa，脂肪变性的截断值＞275 dBm。采用 SPSS 27 软件对临床变量与弹性成像结果之间的关系进行双变量相关和多变量分析。共纳入 79 例符合纳排标准的患者。
17.7%的患者存在晚期纤维化，21.5%的患者存在肝脂肪变性。CAP 与 BMI、腰围、HbA1c、三酰甘油水平和胰岛素剂量呈直接正相关，与 HDL 呈负相关。多元分析显示，腰围、低水平的 HDL 胆固醇和胰岛素剂量与 CAP 值仍存在显著相关性。弹性成像值与 HDL 呈负相关，与 BMI 和胰岛素剂量呈正相关，多元分析仅显示胰岛素剂量与弹性成像值存在相关性。
我们的研究结果表明，临床因素如胰岛素剂量、腰围和 HDL 胆固醇水平可能有助于识别更有可能患有 NAFLD 的 T2D 患者。
